How's your memory?

That's the question General Practitioners will increasingly be asking patients over fifty, only now it will take on a whole new meaning. This is in line with the news that GPs will now be rewarded £55 for each successful dementia diagnosis.

Dementia is being underdiagnosed, according to health authorities, who claim that only half the 800,000 people in the UK estimated to have dementia have been formally diagnosed.

Assuming this figure is correct, the problem still remains that there is no consensus around what dementia actually is and how it differs, in the early stages, from natural, age-related memory loss (which we've previously talked about here).

There is no screening test to accurately predict it and no-one can tell, even if it is dementia, what course it will take. Among the questions which might be asked are: how fast will it progress?  how much will my life be affected? will I die from it? These are perfectly reasonable questions, questions for which we have no answers. On top of this, there is currently no effective intervention.

So, there you have it. A disease which cannot be effectively defined, for which there is no screening test and no effective treatment - sounds like the perfect candidate for a £5m government 'payment for diagnosis' scheme, right?

Those who oppose the move, like the Patients Association, have described it as imposing a bounty on the heads of some patients and can see no good reason for the initiative - especially when there is already a £42m scheme in England offering GP practices payment for performing assessments on those who present with memory problems. Why the clamour to nail diagnoses, they naturally wonder?

Katherine Murphy, Chief Executive of the Patients Association says the proposed new scheme is "a distortion of good medical practice".

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, said the scheme would not be effective without investment in social care and further research to assist in our understanding of dementia. He maintains:

"At the moment, evidence favours either improving social care or investing in research to find new treatments that actually nullify the course of the disease. Until that happens, I can see little point in this initiative."

But the government, it seems, is in no mood for debate on the subject. My advice, then, is to make sure that you and your loved ones are well schooled up on details like the date, prime minister's name and other such trivia before your next trip to the local GP. Because even if you do have early onset dementia by whatever spurious screening criteria are adopted, what's the benefit of knowing about it when there is no effective treatment?

And with a diagnosis will come the risk of being labelled 'incompetent', which means you may be putty in the hands of the system - such a label has serious legal implications. Call me a nay-sayer, call me a denier, but in this fast-emerging brave new world, I'd simply prefer not to know.

Written by Jacqui Hogan

Neurocognitive impairment or just bad memories?

Just recently, there have been a few occasions on which I've had cause to wonder whether I'm headed squarely for dementia - being absolutely certain I'd forgotten my keys and then being surprised to find I had remembered them after all (better than the other way round), and the increasingly common disappearance of a word or thought that had, two seconds previously, been top of mind. Know the feeling? I know I'm not the only one, because just last night I was talking to a friend who also confided she's concerned she's on the same slippery slope, citing similar faux pas.

New research from Cornell University doesn't totally allay our fears, but it does move us closer to identifying reliable methods for evaluating whether such lapses are on the 'healthy age-related memory loss' spectrum or the 'Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD)' spectrum. The results hold promise for detecting neurocognitive impairment early and implementing prophylactic strategies.

CJ Brainerd et al. in the paper 'Dual-retrieval models and neurocognitive impairment' showed that declines in reconstructive memory (that is, recalling a word or event by associating it with clues about its meaning, for example recalling that 'carrots' was presented in a word list by first remembering that the list was associated with food shopping) were associated with cognitive impairment of the type described by MCI and AD, but not with healthy ageing. The type of impairment associated with healthy ageing was recollective memory - that is, an increasing inability to recall a word or event precisely.

So, decline in reconstructive, as opposed to recollective, memory is the all-important distinction and, over a period of 1.5 to 6 years, declines in reconstructive memory were a reliable predictor of of future progression to neurocognitive impairment (either MCI or AD). Of great significance is the finding that loss of recollective memory is a better predictive marker of MCI or AD than the best available genetic markers of such diseases.

So, where was I? The bottom line is, that forgetting the odd word or thought (or keys) here and there is a perfectly normal part of ageing. 'Thingummyjigs' and 'What's-his-names' are just fine. And hopefully this research will lead to greater leverage of the predictive value of reconstructive memory and foster earlier and more effective treatment of neurocognitive morbidity.

Written by Jacqui Hogan